Deposition of calcium in soft tissues can be due to a wide range of diseases such as hydroxyapatite deposition disease (HADD), calcinosis, dermatomyositis, heterotopic ossification, and myositis ossificans.
Imaging of Musculoskeletal Disorders
Soft tissue calcification
Key points
- Soft tissue calcification can be visible on both X-ray and ultrasound images
- The aetiology of these processes is not fully understood.
Calcific tendinopathy – rotator cuff
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Calcific tendinopathy due to HADD – rotator cuff – X-ray
- Deposition of Calcium Hydroxyapatite crystals in soft tissues results in foci of high density visible on X-ray images
- This phenomenon is commonly known as calcific tendinopathy – a manifestation of HADD
- (Same patient as image below)
Calcific tendinopathy – rotator cuff - Ultrasound
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Calcific tendinopathy – rotator cuff - Ultrasound
- (Same patient as image above)
- Ultrasound shows a focus of high reflectivity (white) within distal fibres of the supraspinatus tendon indicating a large calcium deposit
Calcinosis
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Calcinosis
- High density in the soft tissues of the toe is due to calcinosis in this patient with CREST syndrome (Calcinosis, Raynaud’s, Oesophegeal dysfunction, Sclerodactyly, Telangiactasia)
Dermatomyositis
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Dermatomyositis
- Dermatomyositis manifests as ‘sheet-like’ calcifications visible with X-ray
Heterotopic ossification
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Heterotopic ossification
- Heterotopic ossification is the formation of bone spurs and foci of calcification within soft tissues
- This phenomenon is most common around the greater trochanter region following total hip replacement (THR)
- In this image large bone spurs arise from the greater trochanter of the femur which severely restrict the range of hip movement
Myositis ossificans
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Myositis ossificans
- Myositis is an uncommon complication of trauma resulting in bone-like calcifications forming within muscles
- In this image a large area of calcification is visible within the quadriceps compartment of the thigh